15250-m-cuypers

89 PCPCC study protocol 5 BACKGROUND Prostate cancer (Pca) is the most common malignancy in men in the western world, and inThe Netherlands wheremore than 10,000 new prostate cancer patients are diagnosed each year 1 . Incidence is still growing due to earlier detection and an ageing population 2-4 . Based on demographic developments only, the incidence of prostate cancer in The Netherlands is expected to increase by 49% between 2011 and 2030 5 . For the treatment of localized (low and intermediate risk) prostate cancer, the most common curative treatment options include radical prostatectomy, external beam radiotherapy (EBRT), and brachytherapy. Each curative treatment option has a specific risk profile concerning the occurrence of treatment side effects (for example. impotence, incontinence, and bowel problems). Because curative treatment may not always be necessary as initial treatment for low-risk Pca, active surveillance can be considered a valid option for avoiding or deferring the need for curative treatment. Active surveillance has some known psychosocial barriers like anxiety and uncertainty about disease progression which can withhold patients from choosing this option, although active surveillance is increasingly applied in clinical practice 6,7 . Clinical practice guidelines do not provide strong treatment recommendations given a lack of convincing evidence indicating superiority of any of the available options 8 . Choosing the most suitable treatment option therefore requires a patient to evaluate the treatment procedure, risk for side-effects and the chance of success for all available options. Combined with personal preferences and characteristics, identifying the best suitable treatment option is a difficult and stressful exercise for many patients 9,10 . Further complicating factors are clinicians’ misinterpretation of patients’ preferences, (information) needs and the patient’s preferred role in the decision-making process 11-15 . Eventually, this may result in the clinician dominating in the treatment decision-making at the expense of the patients’ preferences. It is possible that expressing a dominant clinician view may contribute to observed regional variations in the management of prostate cancer 16-20 . During the past decade, several decision aids (DAs) have been developed with special focus on prostate cancer care. Instruments range from information booklets to tailored web-based tools. The variety in the formats used may have contributed to the finding that effects on decisional outcomes have been inconsistent across randomized trials and that noeffects on choicehavebeen found 21,22 . Systematic reviews further emphasize that many previous studies are at high risk of selection bias due to inadequate concealment or blinding of data collectors and outcomes assessors, and that more studies are needed to determine how DAs can be implemented best in clinical practice 21,22 .